Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States.
Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States.
J Pediatr Surg. 2018 Mar;53(3):503-507. doi: 10.1016/j.jpedsurg.2017.05.006. Epub 2017 May 11.
Minimal access surgery (MAS) has gained popularity in infants less than 5kg, however, significant challenges still arise in very low weight infants.
A retrospective chart review was performed to identify all infants weighing less than 3kg who underwent an advanced MAS or equivalent open procedure from 2009 to 2016. Advanced case types included Nissen fundoplication, duodenal atresia repair, Ladd procedure, congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, diaphragmatic plication, and pyloric atresia repair. A comparative analysis was performed between the MAS and open cohorts.
A total of 45 advanced MAS cases and 17 open cases met the inclusion criteria. Gestational age and age at operation were similar between the cohorts, while infants who underwent open procedures had significantly lower weight at operation (p=0.003). There were no deaths within 30days related to surgery in either group. Only 3 MAS cases required unintended conversion to open. There were 2 (4.4%) postoperative complications related to surgery in the MAS cohort and 2 (11.8%) in the open cohort.
Advanced MAS may be performed in infants weighing less than 3kg with low mortality, acceptable rates of conversion, and similar rates of complications as open procedures.
Prognosis study.
Level III.
微创外科（MAS）在体重不足 5kg 的婴儿中越来越受欢迎，但在极低体重的婴儿中仍存在重大挑战。
对 2009 年至 2016 年间所有体重不足 3kg 的婴儿进行了回顾性图表审查，这些婴儿接受了高级 MAS 或同等的开放手术。高级病例类型包括尼森胃底折叠术、十二指肠闭锁修复术、Ladd 手术、先天性膈疝修复术、食管闭锁/气管食管瘘修复术、膈折叠术和幽门闭锁修复术。对 MAS 和开放两组进行了对比分析。
共有 45 例高级 MAS 病例和 17 例开放病例符合纳入标准。两组的胎龄和手术年龄相似，而接受开放手术的婴儿手术时体重明显较低（p=0.003）。两组均无 30 天内与手术相关的死亡病例。仅 3 例 MAS 病例需要意外转为开放手术。MAS 组有 2 例（4.4%）与手术相关的术后并发症，开放组有 2 例（11.8%）。
体重不足 3kg 的婴儿可以进行高级 MAS，死亡率低，转换率可接受，并发症发生率与开放手术相似。
预后研究。
III 级。
